EPISODE SUMMARY

This week on The Claim Game, we’re taking a deep dive into the nuts and bolts of one of the most stressful parts of private practice: credentialing. Jeremy sits down with Kay Ward, the founder and CEO of Lanyard Health, a health tech platform that's reshaping how providers get credentialed and stay on top of their status with payers.

Kay, who’s been in the credentialing game for 15 years, shares her journey from a typist to a startup founder, all because she saw an opportunity to solve a massive problem for providers. She explains why credentialing feels so disjointed and burdensome and offers some game-changing advice to help you avoid common pitfalls and delays.

KEYWORDS

Private Practice, Credentialing, Revenue Cycle Management (RCM), Insurance Billing, Payer, Practice Growth, Practice Management, Practice Owners

TAKEAWAYS

The Biggest Fear is Time: The number one question providers have about credentialing is, "How long will it take?". While there's no single answer, you should plan for at least 60 to 120 days, and potentially longer for certain plans like Medicare Advantage and Medicaid.

You Can Be Your Own Bottleneck: One of the most common delays in credentialing is having disorganized or inconsistent information across your documents. A simple error, like putting your name on line one of your W-9 instead of your practice's name, can cause payers to immediately push the application back and create another 30-day delay.

The Waiting Game Never Ends: Credentialing isn't a "set it and forget it" process. You must re-attest your information on platforms like CAQH and Availity every 90 days to comply with regulations like the No Surprises Act. Failure to do so can lead to payers limiting your payments.

DIYing Credentialing Costs You: While it's possible to manage credentialing yourself, the time and energy spent chasing applications and dealing with delays often outweighs the financial savings. Your time is valuable and should be spent on patient care or scaling your business, not navigating the bureaucratic abyss.

Data is Your Power Tool: When it comes to negotiating higher rates with payers, you need data to back up your value. A solid relationship with your biller is crucial because they have the numbers and insights to help you understand if a payer is still feasible for your practice.

CHAPTERS

00:00 Introduction and Technical Setup

03:17 Kay Ward's Journey into Credentialing

07:11 What Really Slows Credentialing Down (and How to Fix It)

11:46 From CAQH to PECOS: Setting Your Practice Up for Success

15:17 The Most Overlooked Mistake That Delays Credentialing

18:55 Recredentialing & Attestations: The Ongoing Responsibility

24:15 The True Cost of DIY Credentialing

29:39 AI Meets Credentialing: Eliminating Delays and Duplication

32:28 How Lanyard Tracks Policy Changes in Real Time

35:00 NCQA Explained: Why It Matters for Providers

36:27 Navigating Sudden Reimbursement Changes

41:50 Proving Your Value: The Key to Better Rates

45:07 Actionable Steps to Fix Credentialing Issues Today

48:17 Case Study: Winning Credentialing Through Communication

50:26 Conclusion: Organization is the Key to Getting Paid

RESOURCES

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Lanyard Health: Visit lanyardhealth.com

Lanyard Health Free Credentialing Checklist: Provider Enrollment Checklist.pdf

Serif Health: Visit serifhealth.com

Get full access to The Claim Game at jeremyzug.substack.com/subscribe